77fd86eb9ec8a70ddbbe5a18d8e074ca 329181.pdf 2d6c35b34149a7e70542d169de2ef9e3aff6d017 329181.pdf dd73506f39b5ecafade9c8affc427f28c8b34892725c6671a1936cf4c9d550c9 329181.pdf Title: Comparing Cytoreductive Nephrectomy with Tumor Thrombectomy Between Open, Laparoscopic,and Robotic Approaches Subject: Background/Objectives: For surgical candidates with metastatic renal cell carcinoma with a tumor thrombus (mRCC-TT), surgery is cytoreductive nephrectomy with tumor thrombectomy (CN-TT). This is carried out through an open (OCN-TT), laparoscopic (LCN-TT), or robotic (RCN-TT) approach. The purpose of this study was to compare survival outcomes to CN-TT by operative approach. Methods: This was a retrospective analysis of all patients with a diagnosis of mRCC-TT, who underwent CN-TT from a multi-institutional database from 1999–2024. Metastatic locations were qualified as either lung, bone, brain, liver, retroperitoneum, adrenal, paraaortic nodes, or other nodes. Progression was defined as radiographic evidence of recurrence or metastasis not seen on imaging prior to CN-TT. Progression locations were all metastatic locales previously noted plus the nephrectomy bed. Overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) were calculated. Comparisons were performed between OCN-TT, LCN-TT, and RCN-TT. Results: A total of 131 patients were included in the analysis (97 OCN-TT, 25 LCN-TT, and 9 RCN-TT). The TT level was not different (p-value > 0.05) by approach (p-value > 0.05). Preoperative tumor size, final pathologic tumor subtype, and postoperative tumor size were equivalent between the three surgical approaches (p-value > 0.05). Rates of progression were equivalent as were all locations of disease progression in the study (p-value > 0.05). Median OS was 1.6 years in OCN-TT, 1.5 years in LCN-TT, and 2.5 years in RCN-TT (p-value = 0.42). Median CSS was 2.1 years in OCN-TT, 3 years in LCN-TT, and 2.5 years in RCN-TT (p-value = 0.86). PFS was 0.8 years in OCN-TT, 1.2 years in LCN-TT, and 1.2 years in RNC-TT (p-value = 0.76). Conclusions: The operative approach does not affect survival outcomes for CN-TT. Surgeon comfort and patient preference should weigh heavily in operative decision making. Keywords: cytoreductive; tumor thrombus; operative approach Author: Maxwell Sandberg, Gregory Russell, Phillip Krol, Mitchell Hayes, Randall Bissette, Reuben Ben David, Kartik Patel, Brejjette Aljabi, Seok-Soon Byun, Oscar Rodriguez Faba, Patricio Garcia Marchinena, Thiago Mourao, Gaetano Ciancio, Charles C. Peyton, Rafael Zanotti, Philippe E. Spiess, Reza Mehrazin, Soroush Rais-Bahrami, Diego Abreu, Stenio de Cassio Zequi and Alejandro R. Rodriguez Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Fri Oct 31 01:40:23 2025 CET ModDate: Fri Oct 31 01:42:17 2025 CET Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 11 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 524467 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- HLYMPC+URWPalladioL-Ital Type 1 Custom yes yes yes 69 0 AHVZWM+URWPalladioL-Bold Type 1 Custom yes yes yes 70 0 QJKHDB+URWPalladioL-Roma Type 1 Custom yes yes yes 71 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 126 0 JIILEJ+PalatinoLinotype TrueType WinAnsi yes yes no 142 0 PLOLAK+VnURWPalladioL Type 1 Custom yes yes yes 253 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-06-20 04:13:02 CEST RepresentationInformation: 329181.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-06-19 09:55:16 CEST Size: 524467 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 297 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Materials and Methods Item: Title: Results Item: Title: Discussion Item: Title: Conclusions Item: Title: References Info: Title: Comparing Cytoreductive Nephrectomy with Tumor Thrombectomy Between Open, Laparoscopic,and Robotic Approaches Author: Maxwell Sandberg, Gregory Russell, Phillip Krol, Mitchell Hayes, Randall Bissette, Reuben Ben David, Kartik Patel, Brejjette Aljabi, Seok-Soon Byun, Oscar Rodriguez Faba, Patricio Garcia Marchinena, Thiago Mourao, Gaetano Ciancio, Charles C. Peyton, Rafael Zanotti, Philippe E. Spiess, Reza Mehrazin, Soroush Rais-Bahrami, Diego Abreu, Stenio de Cassio Zequi and Alejandro R. Rodriguez Subject: Background/Objectives: For surgical candidates with metastatic renal cell carcinoma with a tumor thrombus (mRCC-TT), surgery is cytoreductive nephrectomy with tumor thrombectomy (CN-TT). This is carried out through an open (OCN-TT), laparoscopic (LCN-TT), or robotic (RCN-TT) approach. The purpose of this study was to compare survival outcomes to CN-TT by operative approach. Methods: This was a retrospective analysis of all patients with a diagnosis of mRCC-TT, who underwent CN-TT from a multi-institutional database from 1999–2024. Metastatic locations were qualified as either lung, bone, brain, liver, retroperitoneum, adrenal, paraaortic nodes, or other nodes. Progression was defined as radiographic evidence of recurrence or metastasis not seen on imaging prior to CN-TT. Progression locations were all metastatic locales previously noted plus the nephrectomy bed. Overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) were calculated. Comparisons were performed between OCN-TT, LCN-TT, and RCN-TT. Results: A total of 131 patients were included in the analysis (97 OCN-TT, 25 LCN-TT, and 9 RCN-TT). The TT level was not different (p-value > 0.05) by approach (p-value > 0.05). Preoperative tumor size, final pathologic tumor subtype, and postoperative tumor size were equivalent between the three surgical approaches (p-value > 0.05). Rates of progression were equivalent as were all locations of disease progression in the study (p-value > 0.05). Median OS was 1.6 years in OCN-TT, 1.5 years in LCN-TT, and 2.5 years in RCN-TT (p-value = 0.42). Median CSS was 2.1 years in OCN-TT, 3 years in LCN-TT, and 2.5 years in RCN-TT (p-value = 0.86). PFS was 0.8 years in OCN-TT, 1.2 years in LCN-TT, and 1.2 years in RNC-TT (p-value = 0.76). Conclusions: The operative approach does not affect survival outcomes for CN-TT. Surgeon comfort and patient preference should weigh heavily in operative decision making. 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